General | Cataract | Glaucoma & Macular Degeneration | Ocular Surface Disease & Eyelids | Retina | Miscellaneous

Diplopia (double vision)
Headaches
Legal Blindness & Low Vision Issues
Migraines
Optic Nerve Disorders & Neuro-Ophthalmology
Other
Smoking & Eye Disease
Strabismus and Amblyopia
Stroke
Trauma & Eye Injuries & Eye Safety
Vision & Refractive Errors (and LASIK)

Ischemic optic neuropathy, a condition caused by restricted blood flow to the optic nerve, is the sudden loss of vision in one or sometimes both eyes. It primarily affects the elderly. There are two forms of ischemic optic neuropathy, caused by differing underlying conditions.

Non-arteritic ischemic optic neuropathy (NAION) is usually painless; it is caused by cardiovascular disease. If you have high cholesterol, high blood pressure, diabetes, or if you smoke, you are at higher risk of developing the condition. Unfortunately, there is no cure, and the central or peripheral (side) vision that you have lost cannot be restored. However, treating the underlying causes of your cardiovascular disease can help control non-arteritic ischemic optic neuropathy and prevent further vision loss.

Arteritic ischemic optic neuropathy (AION) is a condition caused by inflammation of the arteries supplying blood to the optic nerve. This inflammation is known as giant cell arteritis (GCA) or temporal arteritis (TA), and its cause is unknown.  Giant cell arteritis rarely occurs in people below 50 years of age, and it typically begins at around age 70. Women are more likely to develop GCA than men, and Caucasians are affected at a much higher rate than people of other races. People of Scandinavian ancestry are at particular risk. If you have polymyalgia rheumatica, you have an increased risk of having GCA as well.

Arteritic ischemic optic neuropathy (AION) is a condition caused by inflammation of the arteries supplying blood to the optic nerve. This inflammation is known as giant cell arteritis (GCA) or temporal arteritis (TA), and its cause is unknown.  Giant cell arteritis rarely occurs in people below 50 years of age, and it typically begins at around age 70. Women are more likely to develop GCA than men, and Caucasians are affected at a much higher rate than people of other races. People of Scandinavian ancestry are at particular risk. If you have polymyalgia rheumatica, you have an increased risk of having GCA as well.

Signs to look for include:

• flu-like symptoms including headache, fatigue, and fever;
• blurred vision;
• double vision;
• scalp tenderness (painful hair brushing);
• jaw pain (painful chewing);
• stiffness or pain in the neck, hip, or arms; and
• unexplained weight loss.

When treated quickly with high doses of corticosteroids (anti-inflammatory medications) there is a good chance your symptoms will be improved and your vision loss may not be permanent.  Diagnosis after vision loss has occurred, however, portends a worse prognosis and places both eyes at risk for permanent vision loss.  A definitive diagnosis can only be made with a biopsy. For this reason, Dr. Haas may begin treatment before a biopsy confirms your diagnosis. You may need to take corticosteroids for as long as a few years, though at lower dosage levels if this diagnosis is made.

Major side effects of corticosteroids include:

• osteoporosis;
• high blood pressure;
• muscle weakness;
• major blood sugar fluctuations; and
• cataracts.

You should discuss the complications of corticosteroid medications and alternative treatment options with Dr. Haas.

Ischemic Optic Neuropathy:    

Optic neuritis is a condition characterized by inflammation of the optic nerve. This nerve is the pathway that carries impulses from the retina in the back of the eye to the brain and enables the brain to interpret the impulses as images. If the nerves are damaged, vision is greatly affected.

This condition may affect one or both eyes, and symptoms may appear slowly or over a few days. Some of these symptoms include blurred or dim vision, abnormal color vision, or pain in the back of the eye socket or when moving the eyes. These symptoms may get worse with heat or exhaustion. If you are experiencing any of these symptoms, see Dr. Haas for an eye examination right away. If optic neuritis goes untreated, symptoms will get worse.

The causes of optic neuritis are known to be associated with various diseases such as mumps, influenza, measles, multiple sclerosis, Leber’s optic neuropathy (a rare eye condition), or vascular occlusions. However, in many cases, optic neuritis occurs with no known cause.

Steroid drugs are used to treat optic neuritis. In most patients, vision will significantly improve or return to normal with treatment. However, those with a pre-existing condition like multiple sclerosis may not recover their normal vision.

Pseudotumor cerebri (PTC) is a condition in which the pressure from the cerebral spinal fluid inside your head is elevated. This can cause problems such as headaches, blurred vision, or loss of vision. The condition is known as pseudotumor cerebri because symptoms can mimic those of an intracranial tumor.

The cerebral spinal fluid (CSF) is a clear fluid that bathes the brain and spinal cord. In cases of PTC, this fluid is blocked from flowing back from the head as it should, leading to high CSF pressure inside the head. The pressure swells the optic disc at the back of the eye, which can damage (sometimes permanently) the optic nerve and cause vision loss. It can also damage the nerves that control eye movement, resulting in double vision.

The causes of PTC are not certain, but they may include the following:

• hormonal influences, in young women;
• antibiotics;
• steroids; and
• high doses of vitamin A.

The most common symptoms of PTC are headache and visual loss. The headache can be located anywhere, but is usually in the back of the head. It may wake you in the middle of the night, and it may worsen with bending or stooping. Other symptoms include:

• dimming, blurring, or graying of vision;
• difficulty seeing to the side;
• brief visual disturbances;
• double vision;
• rushing or ringing noise in the ears; and
• nausea and vomiting.

Dr. Haas will give you a complete eye examination. It may also be necessary for you to have an MRI scan and spinal tap to assure accurate diagnosis and to rule out other CSF abnormalities. The information learned during the eye exam will allow Dr. Haas to appropriately determine what, if any additional diagnostic tests are needed.
If your symptoms are mild, no treatment other than careful monitoring may be necessary. If you require treatment, certain glaucoma medications and diuretics can help lower CSF pressure. Weight loss (10% or more) is an effective treatment in overweight patients. Pressure can also be lowered by draining CSF through repeated spinal taps or a surgical intervention.

If your vision continues to deteriorate after you have begun treatment, surgical techniques may be required to protect the optic nerve from any further damage.

Multiple sclerosis (MS) is an autoimmune disease that causes your body to produce antibodies that mistakenly attack the myelin sheath protecting your nerve tissue. This chronic central nervous system disorder damages the nerves and causes the gradual loss of muscle control, strength, and vision.  Often, the first symptom a person experiences is changes to their vision, and an ophthalmologist is frequently among the first specialist to help in the diagnosis of this disease.

MS affects people differently. Some have only mild symptoms, while others are severely debilitated by the disease. Symptoms of MS vary widely and can include the following:

• numbness, tingling, or weakness in the arms and legs;
• loss of some or all vision, usually affecting one eye at a time;
• double vision;
• blurred vision;
• pain, including eye pain;
• tremors;
• coordination difficulties; and
• dizziness.

If you are experiencing any of these symptoms, it is important to see your doctor immediately. To determine if you have MS, your doctor will take a complete medical history, and you will be given a neurological examination. You might also need an MRI and other tests to diagnose the cause of your symptoms.

Should your doctor confirm that you have MS, there are a number of treatment options. If your symptoms are mild or infrequent, you may require no treatment other than careful monitoring. For more serious cases, there are several medications that can help, as can physical therapy, occupational therapy, and other treatments.

Though there is no cure for multiple sclerosis, the major causes of vision problems associated with the disease are all treatable, and they often resolve on their own. Three common visual problems associated with MS are:

• optic neuritis, or inflammation of the optic nerve, causing blurring, pain, and blind spots, among other things;
• diplopia, or double vision; and
• nystagmus, or involuntary movement of the eyes.

Steroid medications are commonly prescribed for all three conditions. Patching, prism eyeglasses, and perhaps surgery are also effective in treating double vision. Nystagmus may respond to some medications other than steroids, as well. Over time, your brain may adjust to the appearance of black spots and wiggly lines associated with nystagmus, restoring much of your normal vision.

Myasthenia gravis (MG) is a disorder characterized by weakness of the muscles under your voluntary control. MG is caused by a communication breakdown between your nerves and muscles due to an autoimmune condition that has damaged receptors on your muscles. Your autoimmune system is producing antibodies that are adhering to these receptors, blocking chemicals that normally travel from your nerve endings to the receptors.

MG most often affects the muscles of the face, eyes, arms, and legs, as well as the muscles used for chewing and talking. The muscles that control breathing and swallowing can sometimes be involved as well. These are some of the signs of myasthenia gravis:

• drooping eyelids;
• double vision;
• weakness in the arms or legs; and
• difficulty breathing, talking, chewing, or swallowing.

MG can be made worse by fatigue, stress, illness, and by certain medications. Check with your doctor before taking any new prescription or over-the-counter medications. Extreme difficulty with breathing or swallowing requires emergency care.

Dr. Haas, in conjunction with other specialists, can test for MG using a number of methods, including:

• blood testing, to look for abnormal antibodies;
• neurological examination of your physical condition and mental skills;
• nerve conduction testing and single-fiber electromyography, which test the electrical activity in your muscles; and
• edrophonium (tensilon) injection testing, to look for immediate, temporary improvement in your muscle strength.

There is no known cure for MG, but if you seek treatment early when you first experience symptoms, you can manage the condition successfully. There are a number of treatment options to manage your condition, including medication and surgery. You can also receive physical therapy and learn specific coping skills to help improve your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.


Thyroid-Related Ophthalmopathy

The thyroid gland, located in the front of the neck, produces hormones that regulate your body’s metabolism (the process by which the body transforms food into energy).
In a small number of people, the thyroid gland produces either excessive hormone, inadequate hormone, or it inadequately regulates thyroid hormones. An overproduction of thyroid hormone is often associated with a condition known as Graves’ disease; an underproduction is associated with a condition known as Hashimoto’s disease. Atypical regulation of the thyroid hormone can cause problems associated with the structure surrounding the eye and the area within the orbit, and it also can cause subsequent vision problems.

Some eye problems associated with the disease are:

• Eye protrusion: This occurs when the muscles around the eyes swell, which pushes the eye forward. People with this condition look as if they are staring.

• Eyelid retraction: The combination of eyelid swelling and eye protrusion sometimes causes the eyelids to retract and reveal the sclera (the white part) of the eye.

• Dry eye: Because of protrusion and eyelid retraction, the eyes are more exposed to the environment. This causes blurred vision, light sensitivity, dry eye, excessive tearing, irritation, and inflammation.

• Double vision: Muscle swelling may cause double vision.

• Eye bags: Eyelid swelling can cause tissue around the eyes to bulge forward.

These problems are treated by non-surgical and surgical methods. Non-surgical methods include taking steroid medications by mouth to control swelling and inflammation, wearing sunglasses to relieve light sensitivity, and applying lubricating ointment to relieve dry eye. Surgical methods include repositioning the eye muscles, removing scarred tissue, and relieving compression on the optic nerve to preserve sight.

Orbital inflammatory pseudotumor is characterized by inflammation within the orbit, or eye socket that mimics symptoms similar to a tumor in the same site. The cause is still unknown.

Orbital inflammatory pseudotumor usually occurs in only one eye. Symptoms may include:

• red eye;
• bulging eye;
• pain;
• double vision; and
• blurry or decreased vision.

A CT scan and/or ultrasound of your orbits may be ordered to see if there are any signs of inflammation in the orbits or sclera (the white part of your eye), which is a hallmark sign of the condition. In order to rule out other conditions, other tests and a biopsy of orbital tissues could be necessary.

Orbital inflammatory pseudotumor is usually treated with steroid medications. If further treatment is necessary, radiation therapy is another option. In some cases, treatment may fail to eliminate symptoms. In others, treatment will be effective but the symptoms may return, requiring additional treatments as needed.

Strabismus refers to misaligned eyes. Esotropia (“crossed” eyes) occurs when the eyes turn inward. Exotropia (“wall-eye”) occurs when the eyes turn outward. When one eye is higher than the other, it is called hypertropia (for the higher eye) or hypotropia (for the lower eye). Strabismus can be subtle or obvious, and can occur occasionally or constantly. It can affect one eye or shift between the eyes.

Strabismus usually begins in infancy or childhood. Some toddlers have accommodative esotropia. Their eyes cross because they need glasses for farsightedness. But most cases of strabismus do not have a well-understood cause. It seems to develop because the eye muscles are uncoordinated and do not move the eyes together. Acquired strabismus can occasionally occur because of a problem in the brain, an injury to the eye socket, or thyroid eye disease.

When young children develop strabismus, they typically have mild symptoms. They may hold their heads to one side if they can use their eyes together in that position. Or, they may close or cover one eye when it deviates, especially at first. Adults, on the other hand, have more symptoms when they develop strabismus. They have double vision (see a second image) and may lose depth perception. At all ages, strabismus is disturbing. Studies show school children with significant strabismus have self-image problems.

Amblyopia is poor vision in an eye that did not develop normal sight during early childhood. This condition, sometimes referred to as “lazy eye,” can run in families. The main causes of amblyopia are strabismus, refractive errors, or cloudiness of the eye tissues.

Amblyopia affects about 3-4 out of every 100 people. The best time to correct it is during infancy or early childhood, because after the first nine years of life, the visual system is normally fully developed and usually cannot be changed. It is recommended that children have their eyes and vision monitored by their primary care physician at their well-child visits. If there is a family history of amblyopia, children should be screened by an ophthalmologist.

Strabismus, or misaligned eyes, is the most common cause of amblyopia. The eye that is misaligned is ignored by the brain and “turns off.” A refractive error (meaning an eye is nearsighted, farsighted, or has astigmatism) is another cause of amblyopia. If one eye has a very different refractive error from the other eye, or if both eyes have a very strong refractive error, amblyopia can develop in the eye or eyes that are out of focus. The most severe form of amblyopia occurs when cloudiness of the eye tissues prevents any clear image from being processed. This can happen in conditions such as infantile or developmental cataracts.

Amblyopia is detected by finding a difference in vision between the two eyes or poor vision in both eyes. The ophthalmologist will also carefully examine the eyes to see if other eye conditions are causing decreased vision.

Amblyopia is treated by forcing the brain to use the affected eye or eyes. If refractive errors are present, they are corrected with eyeglasses or, less commonly, with contact lenses or refractive surgery. If a cataract or other cloudiness is present, surgery may be necessary to clear the line of sight. Strabismus may require surgery before, during, or after the amblyopia treatment. Patching or blurring the sound eye is then used to improve the vision by forcing the brain to recognize and process information from the affected eye or eyes. Once maximum vision has been obtained, treatment often needs to be continued at least part time for months to years to maintain the recovered vision. The earlier the treatment is begun, the more successful it will be.

Amblyopia (“lazy eye”) is closely related to strabismus. Children learn to suppress double vision so effectively that the deviating eye gradually loses vision. It may be necessary to patch the good eye and wear glasses before treating the strabismus. Amblyopia does not occur when alternate eyes deviate, and adults do not develop amblyopia.

Strabismus is often treated by surgically adjusting the tension on the eye muscles. The goal of surgery is to get the eyes close enough to perfectly straight that it is hard to see any residual deviation. Surgery usually improves the conditions though the results are rarely perfect. Results are usually better in young children. Surgery can be done with local anesthesia in some adults, but requires general anesthesia in children, usually as an outpatient. Prisms and Botox injections of the eye muscles are alternatives to surgery in some cases. Eye exercises alone are rarely effective when large degrees of strabismus or amblyopia are present.

Diplopia is double vision caused by a problem with the muscles that control the eye or the nerves that stimulate those muscles.

Many conditions can cause diplopia. Double vision is usually a symptom of strabismus (misalignment of the eyes), due to the improper movement of one or more eye muscles. Strabismus is most often found in children, but it can develop later in life. A growth in the eyelid pressing on the front of the eyeball can also cause temporary double vision. Rarely, double vision arises because of an abnormality within the eye, such as a dislocation of the eye’s natural lens.

The onset of double vision in adulthood should be brought to the attention of Dr. Haas immediately to exclude the possibility of a tumor, aneurysm, or neurological problem. Two of the primary neurological conditions that could cause diplopia are microvascular cranial nerve palsy (MCNP) and myasthenia gravis (MG).
Microvascular cranial nerve palsy, or “diabetic palsy,” is one of the most common causes of double vision in older people. It occurs more often in patients with diabetes and high blood pressure, when blood flow is blocked to one or more of the six eye muscles that control eye movement. Although there is no known treatment for MCNP, the double vision may be treated by patching either eye. If the double vision persists, prism eyeglasses or eye muscle surgery may be prescribed.

Myasthenia gravis is a disorder characterized by muscle weakness, caused by a communication breakdown between the nerves and the muscles due to an autoimmune condition that targets the neuromuscular junction. It is most common in the muscles of the face, eyes, arms, and legs, and in the muscles used for chewing, swallowing, and talking. Double vision is one of the common indicators of myasthenia gravis. Though there is no known cure for myasthenia gravis, there are a number of treatment options to manage the condition, including medication, surgery, and other procedures. If you have MG, physical therapy can help, and you can learn specific coping skills for improving your daily life. Early detection and treatment of MG is crucial to managing the condition and preventing serious problems with breathing or swallowing, which require emergency care.

Headaches are one of the most common health complaints. They are caused by a variety of factors and can be divided into the following groups:

Tension-type headaches

This is the most common type of headache. The pain may be felt in the forehead, temples, neck, or around the eyes. Doctors are uncertain about the cause of this type of headache but believe they are due to stress, sleeping or working in unusual positions, clenching jaws, grinding teeth, or chewing gum. These kinds of headaches are usually temporary and can be relieved by an over-the-counter pain reliever.

Migraine headaches

This kind of headache is also common. Migraine pain is related to activity in the brain that swells blood vessels of the scalp, causing throbbing pain, nausea, sensitivity to light, sounds, or odors, and pain that increases with movement. The exact cause of migraines is still unknown. About one in 10 people suffer from migraines, and they affect more women than men. Migraines can run in families and can affect young children as well.

Ocular Migraines

These are a migraine headache variant and may or may not coincide with headaches.  People that have ocular migraines may experience auras (shimmering lights, moving lights, translucent lights) that move around in their vision for 15-20 minutes, or they may even have scotomas (dark spots or blurriness) in their vision.  While highly annoying, ocular migraines usually pose no threat to a person’s health.

Cluster headaches

Cluster headaches are less common than migraines and affect more men than women. They are called cluster headaches because they come in daily bouts of 30 minutes to two hours and continue for one to two months. These bouts can occur several times a year. The pain is felt on one side of the head, is very severe, and can be accompanied by tearing or red eye on the affected side, sweating, and stuffy nose.

Eye disease is the least common cause of headaches. Headaches caused by eye disease are usually felt in the eye or brow on the side where the disease occurs. These headaches are often associated with symptoms like blurred vision, halos, and sensitivity to light. Headaches can also be caused by high blood pressure or brain tumors, although headaches caused by brain disease are rare and become dramatically worse over time.

In general, headaches can include symptoms that may affect vision or your eyes, but they are not directly caused by eyestrain.

A thorough examination by your primary physician is recommended for any chronic or recurring headache. An eye exam by Dr. Haas may be helpful in some cases.

Migraine headache is a common neurological condition that occurs in about 20% of the population and in 50% of women. It is not clear how a migraine works, but it is believed that the basic cause is an abnormality of serotonin, which is a chemical used by the brain cells. During a migraine, changes in serotonin levels cause the blood vessels in the brain to constrict. This decreases oxygen supply in the brain. In rare cases, a stroke is possible.

Certain foods like aged cheese, chocolate, red wine, and caffeine may trigger migraines. Hormonal changes during pregnancy, menopause, and menstrual periods also are associated with migraines. People with migraines often have a family history of headaches or prior histories of motion sickness.

Symptoms of migraines include nausea, sensitivity to light or sound, pounding pain, and some visual symptoms, including a blurring spot, an expanding border often described as zigzag lines or shimmering, and vision loss in only one eye. Rare symptoms include double vision or a change in pupil size.

Ocular migraines occur when people experience these abnormal visual sensations, and may or may not be associated with the headache.

Treatments first seek to avoid any known factors that precipitate a migraine attack, including environmental factors, medications, and food. Medications for migraines may be prescribed. If migraines are severe, medication on a regular basis may be necessary.

A stroke is a life-threatening emergency in which the blood supply to the brain is interrupted or severely reduced, depriving it of oxygen and killing brain cells. Quick treatment could save your life and minimize damage to your brain.

Major causes of stroke include:

• high blood pressure;
• high cholesterol;
• diabetes;
• cardiovascular disease;
• obesity; and
• smoking.

Symptoms of stroke include:

• numbness, weakness, or paralysis of your face, arms, or legs—usually on one side of the body;
• pain between the eyes;
• blurred vision, double vision, or decreased vision;
• dizziness, loss of balance, or loss of coordination;
• severe headache, stiff neck, or facial pain;
• difficulty speaking or understanding speech;
• confusion or problems with memory, spatial orientation, or perception; and
• nausea and vomiting.

If you are experiencing these symptoms, seek immediate medical attention by calling 9-1-1. Receiving treatment within three hours of suffering a stroke is shown to dramatically improve your chances of a successful recovery.

There is no treatment for patients who have lost vision due to a stroke. However, you may regain some of the peripheral vision lost from a stroke. Dr. Haas will give you a thorough eye examination to determine how the stroke has affected your vision. He will talk to you about what to expect over time and can help you find resources and training to make the most of your remaining vision.

Refractive Errors

Refractive errors occur when light does not focus properly on the retina because of the shape of the eye. The resulting image is blurred. Common refractive errors are myopia (nearsightedness), hyperopia (farsightedness), astigmatism (distorted vision), and presbyopia (aging eyes).

Emmetropia

An emmetropic eye is of normal length, has a cornea that is perfectly shaped and allows light to focus crisply on the retina without the aid of glasses or contact lenses.  Objects are clear at all distances.

Emmetropia (light focused on the retina):

Myopia

(Click HERE for video)

A myopic eye is longer than a normal eye or has a cornea that is too steep, causing light rays to focus in front of the retina instead of on it. With myopia, close objects appear clear, but distant ones appear blurred.

Myopia:

Hyperopia

A hyperopic eye is shorter than normal or has a cornea that is too flat. The light rays focus beyond the retina instead of on it. Distant objects may appear clear, but close ones appear blurred.

Hyperopia: 

(Click HERE for video)

Astigmatism

The cornea of an astigmatic eye is curved unevenly. Images focus in front of and beyond the retina, causing both close and distant objects to appear blurry.

Astigmatism:  

(Click HERE for video)

Presbyopia

(Click HERE for video)

Presbyopia refers to the hardening of the lens that occurs with age. After the age of 40, the lens becomes more rigid and cannot change shape as easily to accommodate near objects. This makes reading and other tasks performed at close range difficult. Presbyopia can occur in combination with any of the other three refractive errors.  Often, inexpensive over-the-counter reading glasses alone will help with this condition.

Refractive errors are usually corrected with eyeglasses or contact lenses. Sometimes surgery is needed or desirable.

The word “laser” is an acronym for Light Amplification by Stimulated Emission of Radiation. A laser is a concentrated beam of light, created when an electrical current passes through a special material. Used in eye surgery since the 1970s, the laser is popular for its unparalleled degree of precision and predictability. Lasers are being used for an increasing variety of eye diseases.

A laser’s specific wavelength allows energy to be absorbed in selected tissues and not damage surrounding tissues. The laser beam is so precise it can cut notches in a strand of human hair without breaking it.

Thermal lasers convert light to heat. This type of laser seals blood vessels and destroys abnormal tissues. Photoablative lasers cut or sculpt tissue and are used to remove tissue, changing the shape and surface of the eye.

For diabetics with diabetic retinopathy, lasers (pan retinal photocoagulation or focal grids) can preserve vision, sometimes for many years. In treating diabetic retinopathy, the laser light seals leaking blood vessels in the retina, the light-sensitive layer of cells lining the back of the eye. Lasers also treat unusual retinal disorders, including blood vessel problems and tumors.

Also used to treat glaucoma, lasers (peripheral iridotomies) can create a new passage through the iris to relieve eye pressure.  Lasers in glaucoma (argon or selective laser trabeculoplasty) may also improve drainage through the trabecular meshwork in the eye, thereby lowering the overall pressure.

Although lasers do not remove cataracts, they may one day. Right now, they open the posterior capsule (Yag capsulotomy), which often becomes cloudy after cataract surgery, restoring vision in a matter of hours.

More recently, the excimer laser has received a great deal of attention as a tool for permanently correcting refractive errors such as nearsightedness, farsightedness, and astigmatism. Refractive laser surgery can decrease or eliminate the need for eyeglasses and contact lenses by reshaping the cornea.

Until recently, if you were one of the millions of people with a refractive error, eyeglasses and contact lenses were the only options for correcting vision. But with the development of refractive surgery, some people with myopia (nearsightedness), hyperopia (farsightedness), or astigmatism (a cornea with unequal curves) can have their vision improved surgically.

Laser-assisted in situ keratomileusis (LASIK) is a refractive procedure that uses a microkeratome cutting device to create a flap in the cornea and a laser to permanently reshape the cornea. The reshaped cornea helps focus light directly onto the retina to produce clearer vision.

LASIK is usually performed as an outpatient procedure using topical anesthesia with eyedrops. The procedure itself generally takes about 15 minutes. The surgeon creates a flap in the cornea with a microkeratome. The flap is lifted to the side, and the cool beam of the excimer laser is used to remove a thin layer of corneal tissue. The flap is folded back to its normal position and sealed without sutures. The removal of corneal tissue permanently reshapes the cornea.

A clear shield is used to protect the flap for the first day and night after surgery. The vision is usually slightly cloudy immediately after the procedure but clears rapidly, often within just a few hours. Your vision should be clear by the next day. Healing after surgery is often less painful than with other methods of refractive surgery because the laser removes tissue from the inside of the cornea and not the surface. Antibiotic and steroid eyedrops are used several times a day for the first week, along with rewetting drops. After the first week, you should need to use only the rewetting eyedrops.

Some people experience poor night vision after LASIK. The surgery also may result in undercorrection or overcorrection, which can often be improved with a second surgery. More rare and serious complications include a dislocated flap, epithelial ingrowth, and inflammation or infection underneath the flap. Most complications can be managed without any loss of vision. Permanent vision loss is very rare.

The ideal candidate for LASIK has a stable refractive error, has adequate corneal thickness and a normal corneal shape, is free of eye disease, is at least 18 years old, and is willing to accept the potential risks, complications, and side effects of LASIK.

This is a procedure where the laser cuts the flap instead of the microkeratome.  The surgeon creates a flap in the cornea with a special laser called a femtosecond laser. Tiny, quick pulses of laser light are applied to your cornea, creating microscopic bubbles at a specific depth and position within your cornea. The cool beam of a second laser, called an excimer laser, is then used to remove a thin layer of corneal tissue. The flap is folded back to its normal position and sealed without sutures. The removal of corneal tissue permanently reshapes the cornea.

Healing is essentially the same for both types of LASIK.

Wavefront-guided LASIK is an enhanced version of LASIK. It uses a special device to precisely measure the eye’s unique irregularities and variations as well as your need for corrective lenses. This procedure has been compared to taking a fingerprint of the eye. You may benefit from this customized approach.

Wavefront measuring devices, called “analyzers” or “aberrometers,” create a precise map of the eye. It is very detailed and records subtle distortions in your eye’s visual system. Using this map, the excimer laser can be programmed to correct for these measured distortions, giving you clearer vision than was possible before with conventional treatments.

Photorefractive keratectomy (PRK) is one of several refractive surgery procedures used by ophthalmologists to permanently change the shape of the cornea to improve the way it focuses light on the retina.

PRK is an outpatient procedure performed with topical anesthetic eyedrops. It takes only about 15 minutes. The corneal reshaping is similar to LASIK and is performed with an excimer laser, but there is no flap creation.  Instead, the epithelium or outer cell layer of the cornea is completely removed and allowed to heal after the corneal reshaping. 

Immediately following surgery, the eye is patched or a “bandage” contact lens is placed on the eye. Vision is blurry for several days following PRK. It may take a month or longer to achieve your best vision. You may need to use medicated eyedrops for up to three months.  Though healing is longer than from LASIK, the overall cornea will be stronger as there are no flaps made.  There is no risk of late flap complications with PRK simply because there is no flap.

Possible complications of PRK surgery include undercorrection, overcorrection, poor night vision, and corneal scarring. Permanent vision loss is very rare. To be a candidate for the procedure you must have a stable and appropriate refractive error, be free of eye disease, be at least 18 years old, and be willing to accept the potential risks, complications, and side effects of PRK.

Recycling Eyeglasses

The World Health Organization estimates that corrective lenses can improve the eyesight of one-fourth of the world’s population. Unfortunately, for many people a pair of eyeglasses is both unaffordable and unobtainable. The donation of old but useful eyeglasses to the needy in the US and abroad can help solve this problem.

The Lions Clubs International and local Lions Clubs conduct eyeglass-recycling programs. Used glasses are cleaned, repaired, and classified by prescription, then distributed free to needy people in developing countries around the world.

Contact a local Lions Club or call Lions Club International at 630.571.5466 to find a local recycling center. Chapters collect the used prescription eyeglasses, reading glasses, and even sunglasses, and then package and ship them to the centers.

Community services for the visually impaired often have names of those needing glasses. Donating your eyeglasses to any charitable organization will improve the eyesight of those in need.

Every year, hospital emergency rooms treat nearly 40,000 victims of sports eye injuries. All professional and recreational athletes participating in eye-hazardous sports need to wear eye protection. To help prevent sports eye injuries, protective polycarbonate eyewear should be worn whether or not prescription eyewear is needed. All prescription eyewear used during sports should be made from polycarbonate lenses.

The sports causing the most eye injuries are basketball, baseball, and racquet sports, but any sport where an object can fly toward the eye is considered hazardous. Unbreakable eyeglass frames, goggles, or facemasks are required when there is a potential for eye injury. Polycarbonate lenses have the highest impact resistance of any eyeglass material. They are 20 times stronger than ordinary eyeglass material, and while not unbreakable, they do afford the best protection available against eye injury from any high-velocity object.

Helmets with eye shields are recommended for football and other contact sports. Many sports, such as baseball, hockey, and men’s lacrosse, require a helmet with polycarbonate face mask or wire shield, especially for very young athletes. Face guards can be worn over glasses and are used primarily for football, ice hockey, and similar high-risk sports. Some sports such as hockey have established standards for eye protection at the national level.

For high-speed sports such as skiing, wear special frames sturdy enough to protect the eyes from any impact. Wear ultraviolet-absorbing goggles or sunglasses while skiing to protect the eyes from glare, ultraviolet rays, and exposure to weather.

Boxing presents a high risk for eye injury. Unfortunately, there is no adequate protection available.

Contact lenses are not a form of protective eyewear. Contact lens wearers require additional protection when participating in sports, especially if the contacts are of the rigid type.

People with only one functional eye should carefully consider the risks of contact sports. Wearing adequate eye protection is imperative for people with sight in only one eye.

Traumatic optic neuropathy is the sudden, severe loss of vision following blunt injury to the eye or areas surrounding the eye. The optic nerve can be damaged by the blow itself, or as a result of other damage sustained by the eye. Vision loss can be immediate or may take days, weeks, or even months to develop.

Dr. Haas will give you a thorough eye examination, and you will need a neurological examination as well, especially if you lost consciousness after the injury. An MRI or CT scan will confirm the diagnosis of traumatic optic neuropathy and verify that no other damage has occurred due to the injury.

If you have mild symptoms, you might only need close observation. Some patients show some improvement with no medical intervention. However, many patients need treatment with high doses of corticosteroid medication to reduce the inflammation that is causing vision loss.
Major side effects of corticosteroids include:

• osteoporosis;
• high blood pressure;
• muscle weakness; and
• cataracts.

Discuss the complications of corticosteroid use Dr. Haas.

In some cases, corticosteroids do not fully resolve the condition. In these cases, you may need optic nerve decompression surgery.

Bungee cords are thick, elastic cords with metallic hooks on each end that are used for many purposes, but primarily to secure loads onto cars, bicycles, and other objects. Even when used correctly and with care, bungee cords are dangerous and cause many cases of vision-threatening blunt and penetrating trauma to the eye each year.

Bungee cords often accidentally release on one end while being secured, and the metal hooks have also been known to break off or bend straight enough to release from where they have been secured.

Dr. Haas urges you to use extreme caution if you must use bungee cords, and to always use strong safety goggles or glasses every time you secure or release the cords.

Sports-related eye injuries are the leading cause of blindness in children. In recent years, the increasing popularity of paintball war games has lead to many serious, vision-threatening injuries. These injuries are especially common in unorganized paintball activities, when no eye protection is worn. However, injuries often occur when participants remove protective eyewear during play in order to clean it.

Dr. Haas urges you to use extreme caution if you or your children participate in paintball activities. Unfortunately, eyes that have been injured by paintballs have very poor recovery rates, and permanent vision loss is very likely.

Visit an eye-care professional to have yourself or your child fitted with the appropriate protective eyewear before participating in a paintball game or using a paintball gun.

Game participants should also be instructed to create a time-out rule by yelling “time out” or a similar agreed-upon phrase when they need to remove their protective eyewear for cleaning. Better yet, participants should not remove the protective eyewear until they are away from the area where paintball guns are being used and out of range of being hit.

A flying champagne cork is an unguided missile capable of ruining anyone’s party. Since they are small enough to pass by protective facial bones and can travel at high speeds, corks can be very dangerous projectiles and have been known to blind people by direct and severe trauma to an eye

It is important to handle bottles of champagne and other sparkling wines correctly and safely. Be sure the bottle is cold before opening it. The cork in a warm bottle is more likely to pop unexpectedly. Chilling the wine to 45° Fahrenheit also improves its taste.

After removing the cork’s foil covering, carefully remove the wire hood while holding down the cork with the palm of your hand.

Point the bottle away from yourself and others while twisting the cork out.

Every year, fireworks rupture the eyeball, burn the eyes and face, cut the eyelids, and cause corneal abrasions in approximately 2,000 people in the United States alone. One-quarter of these eye injuries result in permanent loss of vision or blindness.

While all fireworks are dangerous, the single most dangerous kind is the small, explosive bottle rocket. Their erratic flight causes injuries to users and bystanders alike.
Sparklers, often given to young children, burn at 1800° Fahrenheit, nearly hot enough to melt gold.

To avoid the dangers of fireworks, attend public fireworks displays instead of having fireworks at home. Amateur backyard displays are dangerous to the person lighting the fireworks as well as to nearby family members, friends, neighbors, and pets. Celebrate safely by letting the professionals put on the show.

At public fireworks displays, follow these safety tips to keep you and your family safe:

• Leave the lighting of fireworks to trained professionals—not only is it safer, it is also cheaper and more spectacular.
• Respect safety barriers set up to allow the pyrotechnicians (firework professionals) to do their jobs safely.
• For the best and safest view, stand at least 500 feet or up to a quarter of a mile away.
• Follow directives given by event staff and public safety personnel such as police and firefighters.
• If you find the remains of unexploded fireworks, do not touch them. Immediately contact the local fire or police department.
• Most important, never let your child play with fireworks. Ever.

If a fireworks injury to the eye does occur, do not touch the eye. Get medical attention at an Emergency Department immediately.

The most common type of eye injury that needs immediate action is a chemical burn. Alkaline materials (lye, plaster, cement, and ammonia) can cause severe damage and even blindness. Solvents, acids, and detergents also can be very harmful to the eye. Eyes should be flushed liberally with water if exposed to any of these agents.

If sterile solutions or eye washes are readily available, use them to flush the affected eye. If not, go to the nearest sink, shower, or hose and immediately begin washing the eye with large amounts of water. If the eye has come in contact with an alkaline agent, it is important to flush the eye for at least 10 minutes or more before even considering going to the doctor. Make sure water is getting under the upper and lower eyelids. After at least 10 minutes of flushing, transport the patient to the nearest emergency room.

Abrasions or scratches of the eyelids and cornea, the clear covering of the eye, occur frequently and can be quite uncomfortable. If the abrasion is dirty, gently cleanse the area with a stream of clean water.

Do not attempt to treat severe blunt trauma or penetrating injuries to the eye. Tape a paper or Styrofoam cup over the injured eye to protect it until proper care can be obtained. Try to avoid strenuous activity if such an injury has occurred and seek proper medical care immediately.

In the case of a blow to the eye, do not assume the injury is minor. The eye should be examined thoroughly by Dr. Haas or another ophthalmologist because vision-threatening damage such as an intraocular bleed or a retinal detachment could be hidden.

First aid is only the first step for emergency treatment. If you experience pain, impaired vision, or any possibility of eye damage, call Dr. Haas or go the emergency room immediately.

If your eye has been cut or pierced by a sharp object like a knife, BB, or piece of metal, you should seek medical help immediately at an Emergency Department. Beyond the damage your eye has already received, there may be pieces of the object somewhere in your eye. These are called intraocular foreign bodies.

Do not apply pressure to your eye with your hand or bandage. If possible, shield your eye by placing a paper cup over it to prevent further damage. If an object is protruding from your eye, it is best, if possible, to leave the object in your eye so that Dr. Haas or another ophthalmologist can determine how and when to best remove it.
Surgery is often required to repair the damage of an injury of this sort, and serious infections can develop that can quickly lead to vision loss. Advanced microsurgical techniques and new antibiotics have helped to improve the chances of saving eyes that are seriously injured in this way, but the overall success of surgeries when an eye has traumatically been ruptured is still low.

It is important that you wear protective eyewear when engaging in activities that can be hazardous to your eyes, whether you are at work, doing chores around the house or yard, or playing sports.

Hyphema is the presence of blood in the front part of the eye. The condition is usually due to blunt trauma of the eye, in which case, it is called traumatic hyphema. Traumatic hyphema often occurs when the eye is struck by a ball, hockey puck, projectile toy, rock, BB gun pellet, bungee cord, paint ball, or a fist. The condition is very noticeable, as you can see blood behind the cornea. The blood may cover all or part of the iris, the colored part of your eye.

If your eye has been struck by an object or if you see blood in the eye, you should have a complete eye exam by Dr. Haas or another ophthalmologist to rule out a more severe eye injury. Most patients receive treatment for traumatic hyphema on an outpatient basis. You will probably receive prescription eyedrops to maintain dilation of the pupil, control inflammation, and reduce eye pressure if it is elevated.

You must avoid doing any strenuous activity and taking aspirin; these may cause more bleeding, which could cause more severe damage and vision problems.
If you have ever had a traumatic hyphema, you should see Dr. Haas or your ophthalmologist annually, because this injury significantly increases your lifelong risk for angle-recession glaucoma, and early detection is critical to prevent vision loss.

It is important that you wear protective eyewear when engaging in activities that can be hazardous to your eyes, whether you are at work, doing chores around the house or yard, or playing sports.

Eye injuries at work are common. Every year approximately 70,000 workers injure their eyes. The Occupational Safety and Health Administration (OSHA) reports that nearly three out of every five injured workers were not wearing eye protection at the time of their accident. Luckily, 90% of all workplace eye injuries are preventable with the use of proper safety eyewear.

The Occupational Safety and Health Administration (OSHA) provides regulations that employers and employees must follow. The American National Standards Institute (ANSI) provides the following standards of eye protection for any workplace task:

• Unprotected workers will not knowingly be subjected to environmental hazards.
• Protective eyewear is required whenever there is a reasonable probability eye injury may occur.
• Employers must provide the type of eye protection best suited to the task to be performed.
• Employees are required to use the eye protectors provided.

The Bureau of Labor Statistics reports that eye injuries in the workplace cost over $467 million annually. A written eye safety program should be implemented in the workplace to help prevent workplace eye injuries. Employers should consider these tips in developing their safety plan:

• Determine the potential for eye injury for the tasks performed by their employees.
• Decide how best to protect against the injury (e.g., dark lenses for welding, face-shield for flying objects, tight seal for chemical spills).
• Identify the visual needs of the job (e.g., magnification, dark lenses).
• Post rules regarding when and how eye protection must be used.
• Provide adequate and readily available supplies of eye protection at all times.
• Instruct employees on appropriate treatment if injury should occur.
• Require vision screening for new employees to diagnose any eye disease.

Any activity where something might fly at the eye puts the eye at risk for an injury. Over one million people suffer eye injuries each year in the United States. Almost 50% of these accidents occur at home, and more than 90% of them could have been prevented.

Minor injuries to the cornea, the clear, protective covering over the front of the eye, can be quite painful. A corneal abrasion is a scratch to the cornea. Appropriate treatment may include an antibiotic eyedrop or ointment to prevent infection and an eye patch for comfort. Sand or other particles can stick to the cornea. Such foreign bodies may be removed with a moistened cotton swab, usually by a doctor. Do not rub the eye.

Regular prescription eyeglasses or contact lenses do not protect the eyes from injury. Some glasses and some types of contact lenses shatter if the eye is hit. People who play sports and wear prescription eyeglasses can have special safety glasses or prescription goggles made of high-impact polycarbonate plastic lenses and special unbreakable frames.

Unfortunately, many people do not think they are at risk for an eye injury until the injury occurs. The majority of eye injuries are easily prevented. Use common sense to reduce the risk of injuries, and be sure to follow safety precautions, including the following:

• Wear safety goggles when using powerful chemicals. Goggles should fit properly to prevent chemicals from getting under them yet still allow air to circulate between the eye and the lens.
• Polycarbonate sports goggles are recommended for all participants of high-impact sports or activities where there is a high risk of eye injury.
• Never use fireworks. Attend public fireworks displays instead of having fireworks at home. Amateur backyard displays are dangerous to the person lighting the fireworks, nearby family members, friends, neighbors, and pets.
• Supervise children when they are handling potentially dangerous objects, such as pencils, scissors, and penknives. Be aware that even common household items such as paper clips, elastic cords, wire coat hangers, rubber bands, and fishhooks can cause a serious eye injury.
• Avoid projectile toys such as darts and bows and arrows. Do not allow children to play with air-powered rifles, pellet guns, and BB guns. They are extremely dangerous and have been reclassified as firearms and removed from toy departments.
• Wear eye protection while mowing the lawn or using a “weed eater.” Stones and debris thrown from moving blades can cause severe eye injuries.
• Always check to make sure that a spray nozzle is pointed away from your face before using.
• Use grease shields to cover frying pans and protect eyes from splattering liquids.
• Wear snug-fitting, completely opaque eyeglasses or goggles to shield your eyes and block all UV light in tanning booths. Tanning facilities are required by the U.S. Food and Drug Administration (FDA) to provide safety goggles, but it is best to obtain your own pair so you will always be prepared. If you use the salon’s goggles, be sure that the salon personnel sterilize them after each use to prevent infection and that the goggles are approved for this particular use.
• Read instructions and safety warnings carefully before using tools, chemicals, ammonia, cleaning supplies, and so on.
• Wear safety goggles and be sure you read the instructions carefully before jump-starting a car. Attach the negative ground of the dead battery last. This cable should be attached to the engine away from the dead battery terminal. Never attach a cable to the negative terminal of the dead battery.
• Never use a match or lighter to look under the hood of a car.

When an eye injury does occur, have Dr. Haas or another ophthalmologist (Eye M.D) examine the eye as soon as possible. Although the injury may not look or feel serious, it could cause serious damage to your eyes. If you have blurred vision, partial loss of vision, double vision, or sharp pains in your eye after an accident, see Dr. Haas or go to a hospital emergency room right away.

Sunglasses are popular for comfort and fashion, but now there is medical evidence supporting the use of sunglasses to protect the long-term health of the eyes by limiting their exposure to ultraviolet (UV) light.

More than a dozen studies have shown that spending hours in the sun without proper eye protection can increase the chances of developing age-related eye diseases like cataracts and macular degeneration. Ophthalmologists and optometrists now recommend wearing UV-absorbent sunglasses and wide-brimmed hats when in the sun long enough to get a suntan or sunburn.

People mistakenly confuse the ability of sunglasses to block UV light with the color and darkness of the lenses. In truth, UV protection comes from a chemical coating applied to the surface of the lens. Shop for sunglasses that absorb 99% to 100% of all UV light. Some lens manufacturers’ labels say "UV absorption up to 400 nm." This is the same thing as 100% UV absorption.

In addition to UV light, sunlight also has low levels of infrared light rays. Infrared wavelengths are invisible and produce heat. The eye seems to tolerate infrared well. Research has not shown a connection between eye disease and infrared light ray exposure.

Polarized lenses cut reflected glare, such as sunlight bouncing off water, pavement, or snow. Sunglasses with polarized lenses are popular and useful for fishing, driving, and skiing. Polarization has nothing to do with UV light absorption, but many polarized lenses are now made with a UV-blocking substance.

Wraparound sunglasses are shaped to keep light from shining around the frames and into the eyes. Studies have shown that enough UV rays enter around ordinary frames to reduce the benefits of protective lenses. Large-framed, close-fitting wraparound sunglasses protect the eyes from all angles. Wraparound sunglasses should be considered by commercial fishermen, mountain climbers, skiers, or anyone who spends time at high altitudes or on the water.

Normal vision, or 20/20 vision, means that a person can read the smallest letters or see the pictures on an eye chart when standing 20 feet away from the chart. Some people cannot see normally even with eyeglasses or contacts because a medical condition affects their vision. These people are called visually impaired or visually disabled.

If a visual impairment limits vision to 20/200, or one-tenth of normal vision, a person is considered legally blind. Being legally blind, however, does not mean a person is totally unable to see. People with 20/20 vision but less than 20 degrees of side (peripheral) vision can also qualify as legally blind. People who see well with only one eye are not considered legally blind, nor are people who wear glasses to see better than 20/200.

Most legally blind people function quite well, especially if they have been visually impaired since childhood. Older children and adults with visual impairments may need magnifying lenses for reading and telescopes for distance viewing. People with very poor vision may need to learn Braille and walk with a seeing-eye dog or a cane.
Young children with visual disabilities should have help from a teacher of the visually impaired and should be evaluated for developmental problems by professionals experienced with visual impairments. Parents may need to be advocates for their children to obtain needed services through the school system.

Visually impaired people of all ages benefit from social service, occupational therapy, and orientation and mobility training. Many new devices are available to help them cope with vision loss, including books on audiotape, scanners that can turn print into Braille, watches that can be “read” with the fingers, and “talking” computers and calculators.

Living With Vision Loss in One Eye

People who lose vision in one eye because of an injury or a medical condition must adapt to a narrower field of vision and loss of depth perception. They may still see small objects as well as before, assuming the other eye is normal.

At first, adults who lose vision in one eye may have a few fender-benders, and they may have difficulty reaching out accurately to shake hands. This is due to the lack of depth perception as well as a narrower field of vision. The patient will soon learn to turn his or her head more when driving, reading, or doing other activities in order to compensate for the lack of depth perception and smaller field of view. With patience and time, they learn to use other clues to help them navigate the world around them and to function normally.

Assuming that the unaffected eye is normal, a person with vision loss in one eye is not considered legally blind. In addition, the patient is also eligible for a driver’s license and is able to work in almost any occupation. There may be some jobs that a person with vision loss in one eye cannot safely perform, but they are few. Dr. Haas and your job safety coordinator can provide advice and guidance.

Low vision is loss of eyesight that makes everyday tasks like reading, writing, crossing the street, or watching television difficult. When vision cannot be improved with eyeglasses, medicine, or surgery, people with low vision need to know how to best maintain their existing vision and best utilize the vision they still have.

Low vision can affect central or peripheral vision, depth of perception, or visual processing.

Low vision may be caused by eye injuries or conditions such as age-related macular degeneration, glaucoma, diabetic retinopathy, or retinitis pigmentosa.
Vision rehabilitation can help people with low vision. You can learn new strategies to complete daily activities, regaining confidence in your ability to live independently despite vision loss.

There are many low vision aids available, such as magnifying spectacles, hand and video magnifiers, and telescopes that can help you make the most of your remaining vision. Learning to adjust lighting appropriately can often improve your vision for reading, cooking, dressing, and walking up and down stairs.

What can you do to prevent vision loss?

Early examinations can help reduce the risk of vision loss. If you are experiencing difficulty seeing, it is very important to visit Dr. Haas to get a comprehensive examination. Diagnosis and possible treatment of your eye condition may slow progression of the vision loss and in some cases can improve vision.
A low vision examination may also be helpful. Rehabilitation may be possible. A low vision examination differs from a normal eye exam in that it is typically longer and involves a number of tests that you may not be familiar with.

Typically, the low vision doctor reviews your medical and ocular history and then asks you for detailed information about your vision problems and how they are affecting your everyday life.

After taking your history, your low vision doctor will do a number of tests to assess your vision. These tests may include:

• refraction to assess your vision and determine if glasses may be of any use;
• dilated internal examination of the eye;
• visual field testing of your peripheral vision;
• ocular function testing for depth perception, color perception, and contrast sensitivity;
• ocular motility testing to determine how well your eyes move; and
• evaluation and trial of many different low vision devices, such as magnifiers, improved lighting, closed-circuit TVs, and electronic devices.

Having frequent eye examinations helps to assure that your eyes will remain as healthy as possible. If you are experiencing difficulty with your vision, it is important to see your ophthalmologist right away. A comprehensive eye examination can catch eye-related problems early and help reduce vision loss.

Resources

Remember, you are not alone, and you deserve access to the information and tools you need to make the most of your sight. For more information about low vision, vision rehabilitation, and low vision aids, use these resources:

American Academy of Ophthalmology Web site
http://www.geteyesmart.org/
www.aao.org

American Foundation for the Blind
11 Penn Plaza, Suite 300
New York, NY 10001
800.232.5463
www.afb.org

Lighthouse International
111 East 59 th Street
New York, NY 10022
800.829.0500
www.lighthouse.org

National Association for Visually Handicapped
22 West 21 st Street, 6 th Floor
New York, NY 10010
212.889.3141
www.navh.org

National Library Service for the Blind and Physically Handicapped
Library of Congress
1291 Taylor Street, NW
Washington, DC 20011
800.424.8567
www.loc.gov/nls

Vision Connection
800.829.0500
www.visionconnection.org

6385 Corporate Drive Suite 307 Colorado Springs CO 80919-5913 United States